Once the diagnosis of prostate cancer has been made the disease has to be staged and graded. The stage refers to the extent and spread of the disease while the grade refers to the nature (aggressiveness) of the particular tumor. Staging will determine the extent of disease and provide important prognostic information that will influence the management decisions.
Staging investigations
PSA
X-rays of lumbar spine and pelvis
Chest X-ray
Radionuclitide bone scan
MTI scan of pelvis
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TNM Staging system
T stage (extent of primary lesion)
T1 - tumour confined to prostate, not palpable or visible on TRUS
T2 - tumour palpable or visible on TRUS but confined to prostate
T3 - spread beyond the prostatic capsule
T3a - extracapsular spread only
T3b - involvement of the seminal vesicles
T4 - invasion into rectal wall, bladder neck or pelvic wall
N (Nodal) status
N0 - regional nodes not involved
N1 - regional nodes involved by tumour
M (Distant Metastases)
M0 - no distant metastases
M1 - distant metastases present
Grading
Grading refers to what the cancer looks like under a microscope. The most commonly used system is the Gleason grade and score. The glandular pattern is compared to that of a normal prostate and scored out of 5, where 1 resembles a pattern very close to normal and 5 resembles severely distorted glandular architecture. The two predominant glandular patterns within the cancer are graded out of 5 and the combined score calculated out of 10. The higher the Gleason score, the more aggressive is the tumour and the worse is the prognosis.
Patients with cancers confined to the prostate (T1 and T2) and no involvement of the lymph nodes or other organs (N0 and M0) are potentially curable by surgery or radiotherapy. Patients with disease beyond the prostate are not curable.
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